Bilu Y, Witztum E
Department of Sociology & Social Anthropology, Hebrew University of Jerusalem.
Cult Med Psychiatry. 1993 Jun;17(2):197-233. doi: 10.1007/BF01379326.
The epistemological gap between the medical reality of mental health practitioners and the sacred reality of their Jewish ultra-orthodox patients poses a major challenge for therapy. Based on our work with psychiatric patients from the ultra-orthodox community of northern Jerusalem, we propose a set of guidelines to cope with this challenge. Basically, we seek to incorporate religiously congruent elements, composed of metaphoric images, narratives and actions, into the wide range of our "secular" treatment modalities in order to respond to the patient's suffering, often expressed through distinctively religious idioms of distress. This endeavor calls for "a temporary suspension of disbelief" on both sides. The guidelines presented include three sets of factors which appear pertinent to working with ultra-orthodox patients. The first set is contextual in nature, dealing with the image of the clinic and its physical setting; the second discusses the necessary role requisites of the therapists; and the third one, accorded a central importance, deals on various levels with the therapeutic interventions administered in terms of form and content. Several case vignettes are presented to illustrate three classes of religiously informed interventions: healing rituals, dream interpretation, and the use of culturally congruent metaphors and stories. In the concluding part we discuss ethical and instrumental issues that the proposed therapeutic guidelines may raise.
心理健康从业者的医学现实与他们犹太极端正统派患者的神圣现实之间的认知差距给治疗带来了重大挑战。基于我们与耶路撒冷北部极端正统派社区的精神病患者的合作，我们提出了一套应对这一挑战的指导方针。基本上，我们试图将由隐喻形象、叙事和行动组成的与宗教相符的元素融入我们广泛的“世俗”治疗方式中，以回应患者的痛苦，这种痛苦常常通过独特的宗教痛苦表达方式表现出来。这一努力需要双方“暂时搁置怀疑”。所提出的指导方针包括三组与治疗极端正统派患者相关的因素。第一组本质上是情境性的，涉及诊所的形象及其物理环境；第二组讨论治疗师的必要角色要求；第三组被赋予核心重要性，从形式和内容方面在多个层面探讨所实施的治疗干预。文中呈现了几个病例 vignettes 来说明三类基于宗教的干预措施：治疗仪式、梦的解析以及使用与文化相符的隐喻和故事。在结论部分，我们讨论了所提出的治疗指导方针可能引发的伦理和工具性问题。
